What Changes, What Doesn't: The NMC Bill Explained
What Changes, What Doesn't: The NMC Bill Explained
How is the National Medical Commission (NMC) different from the Medical Council of the India (MCI) it will replace?
Nearly 70% of the 100-plus member MCI were elected members while the 25-member NMC will have a majority nominated, mostly by the central government.
MCI members could be re-nominated or re-elected. The NMC chairperson and other members nominated by the Centre can’t be renominated. In the MCI, 15 of 100-plus members were enough to make a meeting and its decisions valid. In the NMC it will need 13 of 25 members.
The MCI’s tenure was five years, while the NMC’s is four years except for part-time members, whose tenure is two years. The council was to meet at least once a year while the commission has to meet every quarter.
The executive committee of the council, which took most decisions, consisted of the president, vice-president and between seven and ten members. While the NMC, like the MCI, will have no jurisdiction over the various AIIMS, JIMPER Pondicherry or PGI Chandigarh in most matters, their admissions will now have to be through NEET. Interestingly, the National Board of Examination (NBE) and the post graduate medical degrees it regulates continue outside NMC.
Why is the NMC said to give short shrift to states?
The NMC itself will have 11 part-time members representing states or state medical councils, who were a majority in the MCI. And the tenure of part-time members is just two years, meaning each state will get represented roughly every 10 years. States’ representation is primarily in the medical advisory council, which will include 72 members from states and state councils. But this can only advise the commission. Interestingly, the advisory council will be chaired by the commission’s chairperson and will include all 25 commission members. Thus, these 25 will be part of the advisory council and then decide as the National Medical Commission on whether to accept its advice or not.
Does NMC have any non-medico representation?
Yes. Three of the 25 members of the commission, one in the search committee and one in the medical assessment and rating board, one in the ethics and medical registration board will not be doctors. There are also four in the medical advisory council. Other non-doctors include bureaucrats. The secretary to the commission, also appointed by the Centre, too could be a non-doctor as the bill does not mandate it should be a doctor.
Is the NMC consolidating the Centre’s control over medical education and doctors?
There is a preponderance of the Centre’s nominees in the NMC. Moreover, the central government is the appellate authority for almost all decisions taken by the commission barring decisions on appeal by a doctor against any decision of the ethics and medical registrations board. The bill also gives the Centre the power to give the commission and boards policy directions while clarifying that “the decisions of the Central government whether a question is one of policy or not shall be final.” It also categorically states that the Centre can give directions to state governments for carrying out provisions of the Act and they will have to comply with such directions.
What are the most glaring omissions in the MCI that the NMC Bill has addressed?
MCI decisions were not binding on state medical councils and even if MCI decided to suspend a doctor, the state council often refused to do so. The NMC Bill clearly states that the ethics board of the commission will “exercise appellate jurisdiction with respect to actions taken by state medical councils” on issues of compliance with the ethical code.
Again, the Centre did not have direct powers to take action against the MCI if it violated the IMC Act. The government had to constitute a three-member-commission of inquiry of which one member would be decided by the council. The commission could suggest remedies, and if this was not implemented the government could amend regulations or take steps to ensure implementation.
So, the MCI had to be dissolved through ordinances and any action against the MCI president could be taken only if directed by a court. In the NMC Bill, the Centre has the power to remove the chairperson or any member of the commission for several reasons including if their continuation in office is “prejudicial to public interest” or the person has abused the position or has acquired financial or other interest likely to affect functioning.
Unlike MCI members, NMC members will have to declare assets and liabilities at the time of entering and demitting office. They will also have to give a conflict of interest declaration of professional and commercial engagements or involvements and these are to be displayed on the commission’s website. They will also have a two-year cooling off period after their tenure during which they cannot be employed in any capacity, including as consultant or expert in any private medical institution whose matter they might have dealt with directly or indirectly. This cooling off period, however, can be waived by the Centre.
What does the Bill say on college fees and inspections?
The MCI had no powers to regulate fees. The commission will be “framing guidelines” for determining fees on 50% of seats in private colleges. Critics have pointed out that since guidelines are not justiciable, this is as good as allowing 100% of private seats to be unregulated.
Currently, most states have fee regulatory committees to fix fees. While the MCI inspected medical colleges using faculty from government colleges, the NMC Bill says the medical assessment and rating board can “hire and authorize any third party agency or persons for carrying out inspection”.
Has the NMC dropped all references to bridge course and training of Ayush doctors to deliver primary care in an allopathic set up?
Open reference to a bridge course for Ayush doctors has been dropped. But it lurks in the reference to an annual sitting of the commission with the Central Council of Homoeopathy and the Central Council of Indian Medicine “to enhance the interface” between systems of medicine. In such a sitting, all the members present and voting can “decide on approving specific educational modules or programmes that may be introduced in the undergraduate course and the postgraduate course across medical systems and promote medical pluralism”. The bill also provides for “Community Health Providers” (CHPs) defined as persons granted a licence to practice medicine at mid-level.
Criteria or eligibility to become CHP will be defined through regulations framed under the Act. The Bill merely says that they will be persons “connected with modern scientific medical profession”. The number of CHPs licenced “shall not exceed one-third of the total number of licenced medical practitioners”.
Since there are an estimated 8 lakh plus registered doctors, the number of CHP licences could be as much as 2.7 lakh. CHPs would be allowed to prescribe specified medicines independently in primary and preventive healthcare, but at higher levels “only under the supervision of medical practitioners “. Thus the bridge course seems to have been deferred if not dropped, though the Bill clearly makes space for non-MBBS practitioners.
What does the NMC Bill say about entry and exit exams for doctors?
NEET is to continue as the entry exam and even institutes like AIIMS will have to use it. As for exit, that too will be “a common final year undergraduate medical examination”, National Exit Test, to grant licences to practice medicine. The exit test is expected to become operational within three years of the NMC bill becoming law.
The exit exam will be common for Indian and foreign medical graduates, a long standing demand of foreign medical graduates who have been subjected to a screening test no Indian medical graduate had to clear. This will also mean those who get their MBBS degree from the US, UK, Canada, Australia or New Zealand would also have to pass the exit exam if they want to practice here. Currently students with MBBS degrees from these countries are automatically entitled to practice in India. The exit exam will also serve as an entrance exam for post-graduate education in any institution under this law.
What lacunae has the NMC missed addressing?
The Bill says all state medical councils shall maintain and regularly update the state registers. But as in the IMC Act, there is no stipulation for re-registration or re-accreditation of doctors every few years, as is done in many countries.
This stipulation not being there made it impossible for many state medical councils to maintain an updated register as doctors refused to re-register. Some critics have pointed out that unlike the UGC, which stipulates working conditions and pay for college teachers, the NMC has no provision to regulate working conditions of faculty and resident doctors or on their salary or stipend. The IMC Act too had nothing on these, which was cited by MCI to say it could do nothing about colleges not paying faculty or resident doctors decent and regular wages. ET Healthworld